Financed Planning
for Businesses
QUALIFIER FORM
Client Information
Client Gender
*
Mr. Client
Mrs. Client
Birthdate
*
Health Assessment
*
Please select...
Healthy (Preferred Rating)
Minor health problems (Standard to Table 2 Rating)
Serious Health Problems (Table 3 Rating & Above)
Chronic / Terminal Health Problems (Uninsurable)
Company Name / Marketing Affiliate
Client Networth (including business)
*
Estimate of the client's networth(personal + business)
Type of Business
*
Indicate the type of business owned.
When was the business established?
*
(
)
How old is the above noted business?
Approximate Annual Sales
*
-
Cash-based business?
*
Yes
No
Receivables-based business?
*
Yes
No
-
Client Needs Assessment
Primary Purpose?
*
Retirement Income
Retirement Income & Life Coverage
which choice best suits the client's retirement planning goals.
Client Investment Philosophy
*
Please select...
Very Conservative
Conservative
Slightly Aggressive
Aggressive
Client's concern with retirement funding?
*
Very Concerned
Slightly Cocerned
Not Concerned
Client's concern with asset protection?
*
Very Concerned
Slightly Concerned
Not Concerned
Contact Information
First Name
*
Contact / Agent First Name
Last Name
*
Contact / Agent First Name
Company
*
Company Name / Marketing Affiliate
Phone
*
Best phone number to contact you.
Email
*
What is the best day and time to reach you?
Sat.
Sun.
Mon.
Tues.
Wed.
Thurs.
Fri.
How did you hear about CFS?
*
Please select...
CFS Agent / Associate Referral
CFS Newswire
Website
Search Engine (Google, Yahoo, etc.)
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Other
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